Meaning in life is a fundamental protective factor in the context of psychopathology
Authors: Michael F. Steger
Journal: World Psychiatry (2022)

In the midst of profound upheavals to the world, the question of what life means feels urgent and acute. Decades ago, the inspiring advocate for the human need for meaning, the psychiatrist V. Frankl, argued that the 20th century was marked by a widespread affliction in which people complained of "the feeling of the total and ultimate meaninglessness of their lives. They lack the awareness of a meaning worth living for. They are haunted by the experience of their inner emptiness, a void within themselves"1, p.128. Such words could have been uttered last week. In contemporary life, the haunting inner emptiness that Frankl spoke of seems increasingly accompanied by a haunting outer emptiness, as the world whirs through accelerating technological, social and ecological convulsions. Fortunately, a wealth of empirical research has emerged to provide guidance on how meaning in life may buttress us against such pressures. Meaning in life has been defined as people's subjective judgments that their lives are marked by coherence, purpose and significance, which emerge from "the web of connections, interpretations, aspirations and evaluations that a) make our experiences comprehensible, b) direct our efforts toward desired futures, and c) provide a sense that our lives matter and are worthwhile"2. Thus, coherence is our cognitive capacity to make sense of our lives and perceive predictability and consistency. Purpose is our motivational capacity to strive for long-term aspirations that are personally important. Significance is our evaluative capacity to see inherent value and worth in being alive and recognize that we matter. Despite this tridimensional conceptualization, the vast bulk of research has been conducted using general "meaning and purpose" measures, such as the Meaning in Life Questionnaire (MLQ)3. The MLQ is brief, psychometrically robust, has been used globally, and seems to have helped facilitate an explosion in research on meaning in life. It is no exaggeration that thousands of empirical studies have been published demonstrating that meaning in life is a foundational component of well-being. Meaning in life is thought to support well-being by integrating cognitive and motivational aspects of functional relevance to people, such as identity and self-worth, attachment and belonging, and self-concordant goal-setting and goal pursuit1-3. Meaning in life gives people a reason to live and a basis to make sense of their life experiences – past, present and future. It is encouraging to see considerable research aiming to document how meaning in life relates to and interacts with psychopathology and treatment for mental disorders, particularly psychotherapies. Unsurprisingly, most research shows that people with diagnosed disorders or with elevated symptoms of psychopathology report lower levels of meaning in life and are more likely to score in the "my life is meaningless" range on measures. Research often finds that meaning in life has especially strong inverse relations with the presence and severity of depression symptoms4, although studies have also focused on schizophrenia, eating disorders, substance use disorders, anxiety disorders, and post-traumatic stress disorder, with multiple papers publish­ed on each of these disorders. Beyond diagnosis- and symptom-focused studies, research has indicated that meaning in life appears to play a protective role against suicidal ideation, suicide attempts, and non-suicidal self-harm. Among 199 patients surveyed in a psychiatric emergency department in Switzerland, lower scores on the presence of meaning in life scale of the MLQ were related to higher levels of suicidal ideation and suicide attempts over and above socio-demographic variables5. This protective role of meaning in life also holds for an array of stressors and mental health challenges, including the psychological strain of the COVID-19 pandemic. Meaning in life scores collected among a sample of university students in China were positively related to prosocial behavior and negatively related to severity of depression, stress, anxiety, and negative emotionality in a survey conducted in February-March 2020, when the initial tumult of the pandemic was mounting fearsomely in China6. People need not be left to their own devices in seeking the benefits of greater meaning in their lives. Evidence is abundant that psychotherapies and other treatments are reflected in increased meaning in life4. A meta-analysis of 33 randomized controlled trials found significant effects in increasing meaning in life for several psychotherapies, narrative methods (i.e., individuals reviewing and writing about their lives), mindfulness techniques, and psychoeducational approaches7. An earlier meta-analysis reinforces these conclusions in a larger body of 60 interventions that were not limited to controlled trials8. Even among patients who are facing long-term mental health challenges, maintaining treatment adherence seems to assist in helping build a sense of meaning in life. In a study of 60 individuals with schizophrenia diagnoses and psychiatric histories at least 5 years in duration, meaning in life was positively related to treatment adherence, in addition to being inversely related to depression symptoms and positively to quality of life9. Meaning in life is a construct that is relevant and predictive across the continuum of psychological functioning, from individuals receiving inpatient psychiatric care to those experiencing high levels of well-being. Further, measures with high utility and robust psychometric properties are readily available and are collectively shown to reflect positive treatment progress and outcomes. Incorporating explicitly meaning-focused elements into treatment also benefits patient progress and outcomes. Paying attention to the meaning of patients' lives would be worthwhile throughout the course of treatment, recovery, and psychological health maintenance. Particularly so in an era of significant psychological stress, when so many feel haunted by inner emptiness.